Nursing homes are increasingly the place of care and death for older persons. However, the quality of care provided to nursing home residents at the end-of-life (EOL) has been reported to be inadequate. Comparative empirical evidence on the quality of EOL care in US nursing homes is lacking and there are currently no risk adjusted measures of EOL quality of care in nursing homes. The objective of the proposed study is to develop and validate individual indicators and a composite measure for assessing EOL quality of care in nursing homes, and to identify characteristics of facilities associated with superior EOL quality of care. The specific aims of this project are to: 1) Develop and validate individual and composite EOL indicators of quality. 2) Examine cross-sectional and longitudinal variations in individual indicators and in the composite quality measure, for example across states, facility ownership type, etc. 3) Identify EOL practice patterns and characteristics of nursing homes that are associated with better individual and composite quality measures. The measures developed in the course of this study could provide a prototype for EOL quality measures to be incorporated into publicly disseminated report cards such as the Medicare Nursing Home Compare. Empirical insights gained from this project may be used to test and implement strategies for improving the quality of EOL care in nursing homes. PUBLIC HEALTH RELEVANCE This project will improve public health by developing a prototype for end-of-life quality measures that could be incorporated into publicly disseminated report cards such as the Nursing Home Compare. Lessons learned from this project may be used to implement and test strategies for improving the quality of end-of-life care in nursing homes.